Published online Dec 18, 2017. doi: 10.5312/wjo.v8.i12.956
Peer-review started: February 13, 2017
First decision: May 10, 2017
Revised: July 29, 2017
Accepted: August 15, 2017
Article in press: August 16, 2017
Published online: December 18, 2017
Processing time: 322 Days and 16.7 Hours
To clarify the quality of the studies indicating lesion size and/or containment as prognostic indicators of bone marrow stimulation (BMS) for osteochondral lesions of the talus (OLT).
Two reviewers searched the PubMed/MEDLINE and EMBASE databases using specific terms on March 2015 in accordance with the Preferred Reporting Items for Systemic Reviews and Meta-Analyses guidelines. Predetermined variables were extracted for all the included studies. Level of evidence (LOE) was determined using previously published criteria by the Journal of Bone and Joint Surgery and methodological quality of evidence (MQOE) was evaluated using the Modified Coleman Methodology Score.
This review included 22 studies. Overall, 21 of the 22 (95.5%) included studies were level IV or level III evidences. The remaining study was a level II evidence. MQOE analysis revealed 14 of the 22 (63.6%) included studies having fair quality, 7 (31.8%) studies having poor quality and only 1 study having excellent quality.
The evidence supporting the use of lesion size and containment as prognostic indicators of BMS for OLTs has been shown to be of low quality.
Core tip: Bone marrow stimulation (BMS) is a reparative procedure for osteochondral lesions of the talus, promising approximately 85% success rates in the short- and mid-term. To date, the prognostic factors for BMS are lesion size and containment of the lesion. No other factors have been shown to be universal predictors. However, the level of evidence and methodological quality of evidence for clinical studies accompanying both the lesion sizes and containment are low. Overall, 95.5% of the studies included in the analysis are level IV or level III. No level I study was identified. The methodological qualities of the included studies were not strong. In particular, the scores of “primarily evaluates outcome criteria and recruitment rates” were low.